BILL NUMBER: SB 111	CHAPTERED  09/27/01

	CHAPTER  358
	FILED WITH SECRETARY OF STATE  SEPTEMBER 27, 2001
	APPROVED BY GOVERNOR  SEPTEMBER 26, 2001
	PASSED THE SENATE  SEPTEMBER 4, 2001
	PASSED THE ASSEMBLY  JULY 20, 2001
	AMENDED IN ASSEMBLY  JULY 17, 2001
	AMENDED IN ASSEMBLY  JULY 5, 2001
	AMENDED IN SENATE  APRIL 17, 2001
	AMENDED IN SENATE  MARCH 26, 2001

INTRODUCED BY   Senator Alpert

                        JANUARY 23, 2001

   An act to amend Sections 2069 and 2070 of the Business and
Professions Code, relating to medical assistants.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 111, Alpert.  Medical assistants.
   Existing law authorizes a medical assistant to perform specified
services relating to administration of medication, performance of
skin tests and simple routine medical tasks and procedures, and
performance of venipuncture or skin puncture for withdrawing blood
upon specific authorization from and under the supervision of a
licensed physician and surgeon, podiatrist, or a physician and
surgeon or podiatrist group or corporation.  Pursuant to existing
law, the specific authorization is required to come from a
supervising physician and surgeon or podiatrist, and supervision by a
licensed physician and surgeon or podiatrist is required to be
within the scope of his or her practice.
   This bill would also authorize a medical assistant to perform the
above services in specified clinics for a physician assistant, nurse
practitioner, or nurse-midwife.  In those cases, the bill would
require that specific authorization for the services be given by a
physician assistant, nurse practitioner, or nurse-midwife, and that
supervision over the services be performed by a physician assistant,
nurse practitioner, or nurse-midwife.  The bill would authorize a
physician and surgeon in these specified clinics to provide written
instructions for medical assistants, regarding the performance of
tasks or duties, which may allow a nurse practitioner, nurse-midwife,
or physician assistant to supervise tasks authorized by a physician
and surgeon and may allow the tasks to be performed when the
supervising physician and surgeon is not onsite, so long as certain
conditions are met.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  The California Legislature finds and declares all of
the following:
   (a) Every year, nonprofit licensed community clinics provide
primary health care services, including more than 1.7 million
uncompensated visits, to medically underserved populations.
Currently, there are 7.3 million uninsured Californians,
necessitating expanded access to quality health care through
community clinics.  The Legislature intends, therefore, to eliminate
unnecessary barriers to the utilization of qualified, competent
medical assistants who provide care in community clinics.
   (b) Medical assistants are entry-level health care personnel who
are authorized under the law to provide care in community clinics,
and can only perform medical tasks within their scope of practice, as
established by the Medical Board of California.  These health care
workers are often recruited from within the local community because
of their linguistic and cultural sensitivity, which are essential to
caring, competent, quality health care.  Nothing in this bill is
intended to expand the scope of practice of medical assistants,
including the performance of any clinical laboratory test or
examination for which they are not authorized under the appropriate
state or federal laboratory law.
   (c) Nurse practitioners, nurse-midwives, and physician assistants
are authorized under the law to train, supervise, and assign tasks to
medical assistants, so long as the tasks are within the scope of
practice of the medical assistant.  However, medical assistants are
authorized to perform services only when a physician is physically
present at the office or clinic.  The sole purpose of this bill is to
provide nurse practitioners, nurse-midwives, and physician
assistants with the legal authority to supervise the work of medical
assistants when the physician is not at the clinic site, when so
delegated by the supervising physician.  Nothing in this bill is
intended to increase the scope of practice of any nurse practitioner,
nurse-midwife, or physician assistant to include the authority to
direct a clinical laboratory licensed under state or federal
laboratory law.
  SEC. 2.  Section 2069 of the Business and Professions Code is
amended to read:
   2069.  (a) (1) Notwithstanding any other provision of law, a
medical assistant may administer medication only by intradermal,
subcutaneous, or intramuscular injections and perform skin tests and
additional technical supportive services upon the specific
authorization and supervision of a licensed physician and surgeon or
a licensed podiatrist.  A medical assistant may also perform all
these tasks and services in a clinic licensed pursuant to subdivision
(a) of Section 1204 of the Health and Safety Code upon the specific
authorization of a physician assistant, a nurse practitioner, or a
nurse-midwife.
   (2) The supervising physician and surgeon at a clinic described in
paragraph (1) may, at his or her discretion, in consultation with
the nurse practitioner, nurse-midwife, or physician assistant provide
written instructions to be followed by a medical assistant in the
performance of tasks or supportive services.  These written
instructions may provide that the supervisory function for the
medical assistant for these tasks or supportive services may be
delegated to the nurse practitioner, nurse-midwife, or physician
assistant within the standardized procedures or protocol, and that
tasks may be performed when the supervising physician and surgeon is
not onsite, so long as the following apply:
   (A) The nurse practitioner or nurse-midwife is functioning
pursuant to standardized procedures, as defined by Section 2725, or
protocol.  The standardized procedures or protocol shall be developed
and approved by the supervising physician and surgeon, the nurse
practitioner or nurse-midwife, and the facility administrator or his
or her designee.
   (B) The physician assistant is functioning pursuant to regulated
services defined in Section 3502 and is approved to do so by the
supervising physician or surgeon.
   (b) As used in this section and Sections 2070 and 2071, the
following definitions shall apply:
   (1) "Medical assistant" means a person who may be unlicensed, who
performs basic administrative, clerical, and technical supportive
services in compliance with this section and Section 2070 for a
licensed physician and surgeon or a licensed podiatrist, or group
thereof, for a medical or podiatry corporation, for a physician
assistant, a nurse practitioner, or a nurse-midwife as provided in
subdivision (a), or for a health care service plan, who is at least
18 years of age, and who has had at least the minimum amount of hours
of appropriate training pursuant to standards established by the
Division of Licensing.  The medical assistant shall be issued a
certificate by the training institution or instructor indicating
satisfactory completion of the required training.  A copy of the
certificate shall be retained as a record by each employer of the
medical assistant.
   (2) "Specific authorization" means a specific written order
prepared by the supervising physician and surgeon or the supervising
podiatrist, or the physician assistant, the nurse practitioner, or
the nurse-midwife as provided in subdivision (a), authorizing the
procedures to be performed on a patient, which shall be placed in the
patient's medical record, or a standing order prepared by the
supervising physician and surgeon or the supervising podiatrist, or
the physician assistant, the nurse practitioner, or the nurse-midwife
as provided in subdivision (a), authorizing the procedures to be
performed, the duration of which shall be consistent with accepted
medical practice.  A notation of the standing order shall be placed
on the patient's medical record.
   (3) "Supervision" means the supervision of procedures authorized
by this section by the following practitioners, within the scope of
their respective practices, who shall be physically present in the
treatment facility during the performance of those procedures:
   (A) A licensed physician and surgeon.
   (B) A licensed podiatrist.
   (C) A physician assistant, nurse practitioner, or nurse-midwife as
provided in subdivision (a).
   (4) "Technical supportive services" means simple routine medical
tasks and procedures that may be safely performed by a medical
assistant who has limited training and who functions under the
supervision of a licensed physician and surgeon or a licensed
podiatrist, or a physician assistant, a nurse practitioner, or a
nurse-midwife as provided in subdivision (a).
   (c) Nothing in this section shall be construed as authorizing the
licensure of medical assistants.  Nothing in this section shall be
construed as authorizing the administration of local anesthetic
agents by a medical assistant.  Nothing in this section shall be
construed as authorizing the division to adopt any regulations that
violate the prohibitions on diagnosis or treatment in Section 2052.
   (d) Notwithstanding any other provision of law, a medical
assistant may not be employed for inpatient care in a licensed
general acute care hospital as defined in subdivision (a) of Section
1250 of the Health and Safety Code.
  SEC. 3.  Section 2070 of the Business and Professions Code is
amended to read:
   2070.  Notwithstanding any other provision of law, a medical
assistant may perform venipuncture or skin puncture for the purposes
of withdrawing blood upon specific authorization and under the
supervision of a licensed physician and surgeon or a licensed
podiatrist, or a physician assistant, a nurse practitioner, or a
nurse-midwife as provided in subdivision (a) of Section 2069, if
prior thereto the medical assistant has had at least the minimum
amount of hours of appropriate training pursuant to standards
established by the Division of Licensing.  The medical assistant
shall be issued a certificate by the training institution or
instructor indicating satisfactory completion of the training
required.  A copy of the certificate shall be retained as a record by
each employer of the medical assistant.